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Research ArticleBRAIN

Parent Vessel Occlusion for Vertebrobasilar Fusiform and Dissecting Aneurysms

R. Leibowitz, H.M. Do, M.L. Marcellus, S.D. Chang, G.K. Steinberg and M.P. Marks
American Journal of Neuroradiology May 2003, 24 (5) 902-907;
R. Leibowitz
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H.M. Do
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M.L. Marcellus
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S.D. Chang
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G.K. Steinberg
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M.P. Marks
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    Fig 1.

    Images from the case of a 46-year-old man (patient 3 in group I) who suffered SAH from a fusiform aneurysm of the distal intracranial right vertebral artery.

    A, Anteroposterior projection angiogram of the right vertebral artery disclosed a fusiform aneurysm of the distal intracranial portion (arrow) that is proximal to the vertebrobasilar junction and distal to the right posterior-inferior cerebellar artery (PICA, arrowhead).

    B, Aneurysm and distal vertebral artery were embolized with coils. Lateral projection control angiogram of the right vertebral artery, obtained after embolization, shows preservation of flow to the right posterior-inferior cerebellar and basilar arteries.

    C, Anteroposterior projection angiogram of the left vertebral artery shows preservation of flow to the right posterior-inferior cerebellar and basilar arteries. The patient achieved complete recovery and remained neurologically normal.

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    Fig 2.

    Images from the case of a 71-year-old man (patient 4 in group II) with a fusiform vertebrobasilar aneurysm with mass effect on the left medulla, causing referable symptoms.

    A, Initial T2-weighted MR image of the posterior fossa shows mass effect and compression of the left medulla (arrows) from the aneurysmally dilated distal left vertebral artery (arrowheads). Note the high signal intensity within the aneurysm, signifying slow disturbed flow.

    B, Anteroposterior projection angiogram of the left vertebral artery.

    C, Oblique projection angiogram of the left vertebral artery shows a fusiform aneurysm extending from the distal intracranial left vertebral artery into the proximal basilar artery (arrows). Contrast material refluxed into the right vertebral artery. Note that the origin of the left posterior-inferior cerebellar artery is from the proximal basilar artery (arrowhead). The patient tolerated a 30-min temporary balloon occlusion of the left vertebral artery just proximal to the vertebrobasilar junction.

    D, Lateral projection angiogram of the left vertebral artery, obtained after embolization, confirms coil occlusion of the artery.

    E, Follow-up MR angiogram, obtained at 24 hr, shows preservation of blood flow to the posterior fossa via the right vertebral artery with high signal intensity slow flow and/or thrombus within the distal left vertebral aneurysm (arrowhead).

    F, Patient’s symptoms improved after embolization. Axial view T2-weighted MR image obtained 18 months after embolization shows thrombosis of the proximal aneurysmal sac, as evidenced by low signal intensity (arrowhead).

    G, MR angiogram obtained 18 months after embolization shows thrombosis of the proximal aneurysmal sac, as evidenced by lack of flow-related enhancement (arrows). Continued flow-related enhancement can be seen in the basilar artery (arrowhead).

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    TABLE 1:

    Clinical outcomes for patients undergoing parent vessel occlusion of the vertebral artery

    Age (y)/SexGroupAneurysm Location and TypeMode of PresentationMethod of EmbolizationMonths of Follow-upClinical Presentation (Modified Rankin Score)Clinical Outcome (Modified Rankin Score)
    148/FIR VA disSAHCoil242
    256/MIL VA fusSAHCoil1454
    346/MIR VA fusSAHCoil1010
    452/MIL VA disSAHBalloon2351
    567/FIR VA fusSAHCoil7253
    676/MIL VA fusSAHCoil7653
    Mean5825.3
    752/MIIL VB fusSAHBalloon1434
    845/MIIB VA dis L VA paSAHCoil1254
    978/MIIL VB fusMass effectCoil3036
    1061/MIIBA fus L VA disSAHBalloon + coil1*56
    1171/MIIL VB fusMass effectCoil1911
    1266/MIIL VB fusMass effectCoil946
    1378/MIIR VB fusMass effectBalloon4**36
    Mean6412.7
    Overall mean6122.0
    • Note.—I indicates parent vessel occlusion for angiographic cure; II, parent vessel occlusion for angiographic palliation; R, right; L, left; VA, vertebral artery; dis, acute dissecting aneurysm; fus, chronic fusiform aneurysm; VB, vertebrobasilar; pa, pseudoaneurysm; SAH, subarachnoid hemorrhage.

    • * Deceased at 1 month after procedure.

    • ** Deceased at 4 months after procedure; died in sleep.

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American Journal of Neuroradiology: 24 (5)
American Journal of Neuroradiology
Vol. 24, Issue 5
1 May 2003
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Cite this article
R. Leibowitz, H.M. Do, M.L. Marcellus, S.D. Chang, G.K. Steinberg, M.P. Marks
Parent Vessel Occlusion for Vertebrobasilar Fusiform and Dissecting Aneurysms
American Journal of Neuroradiology May 2003, 24 (5) 902-907;

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Parent Vessel Occlusion for Vertebrobasilar Fusiform and Dissecting Aneurysms
R. Leibowitz, H.M. Do, M.L. Marcellus, S.D. Chang, G.K. Steinberg, M.P. Marks
American Journal of Neuroradiology May 2003, 24 (5) 902-907;
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